General Medicine
Chronic Kidney Disease
Chronic kidney disease for MBBS: staging by filtration rate and albuminuria, anaemia and mineral bone disorder, progression control and dialysis, mapped to NMC codes IM10.5 to IM10.31.
MedNext Academy | 3 min read
Chronic Kidney Disease
Chronic kidney disease for MBBS: staging by filtration rate and albuminuria, anaemia and mineral bone disorder, progression control and dialysis, mapped to NMC codes IM10.5 to IM10.31.
This chapter covers chronic kidney disease, its staging by filtration rate and albuminuria, and the systemic complications of anaemia and mineral bone disorder. It emphasises the measures that slow progression, dietary counselling and the choice between dialysis and transplantation in end-stage disease.
High-yield: Chronic Kidney Disease
- Chronic kidney disease is a sustained reduction in kidney function or evidence of kidney damage lasting three months or more.
- Diabetes and hypertension are the two leading causes of chronic kidney disease.
- The disease is staged by the estimated glomerular filtration rate and the degree of albuminuria.
- The estimated glomerular filtration rate is calculated from serum creatinine, age, sex and body characteristics.
- Anaemia of chronic kidney disease is due to reduced erythropoietin production and is treated with erythropoiesis-stimulating agents and iron.
- Mineral and bone disorder features low calcium, high phosphate, high parathyroid hormone and low active vitamin D.
- Blood pressure control and blockade of the renin-angiotensin system slow the progression of proteinuric disease.
- SGLT2 inhibitors are now used to slow progression in diabetic and proteinuric chronic kidney disease.
- Small kidneys on ultrasound suggest chronicity, whereas normal-sized kidneys favour an acute process.
- Cardiovascular disease is the leading cause of death in chronic kidney disease.
- Hyperkalaemia and metabolic acidosis worsen as function declines and need dietary and pharmacological control.
- A dietitian-supervised renal diet restricts sodium, potassium and phosphate while maintaining adequate protein.
- Renal replacement therapy options are haemodialysis, peritoneal dialysis and transplantation.
- Transplantation offers the best survival and quality of life for suitable patients.
- Timely referral and vascular access planning improve outcomes for those approaching end-stage disease.
Chronic kidney disease essentials
- **Leading causes:** Diabetes and hypertension account for most chronic kidney disease.
- **Staging:** By estimated glomerular filtration rate and the degree of albuminuria.
- **Complications:** Anaemia from low erythropoietin and mineral bone disorder with high phosphate and parathyroid hormone.
- **Slowing progression:** Blood pressure control, renin-angiotensin blockade and SGLT2 inhibitors.
NMC competencies in this chapter
- **IM10.16:** Kidney function, mineral and urine chemistry tests
- **IM10.17:** Calculated indices of renal function
- **IM10.19:** Renal ultrasound in chronic kidney disease
- **IM10.23:** Communicating the diagnosis and follow-up
- **IM10.24:** Renal diet counselling
- **IM10.26:** Supportive therapy in chronic kidney disease
- **IM10.27:** Indications for renal dialysis
- **IM10.28:** Renal replacement therapy options
Frequently Asked Questions
How is chronic kidney disease staged?
It is staged by the estimated glomerular filtration rate into stages one to five and further categorised by the degree of albuminuria, which together predict progression and risk.
Why does chronic kidney disease cause anaemia?
The diseased kidney produces less erythropoietin, causing a normocytic anaemia that is treated with erythropoiesis-stimulating agents once iron stores are replete.
What slows the progression of chronic kidney disease?
Blood pressure control, blockade of the renin-angiotensin system in proteinuric disease and SGLT2 inhibitors all slow progression, alongside glycaemic control in diabetes.
How does this chapter help for NEET-PG?
Staging, the mineral bone disorder pattern, anaemia management and dialysis indications are recurring exam themes that map directly to questions.
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